Boston Breast Imaging
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Case 01
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Answer:
DCIS or less frequently invasive cancer can present as calcifications without enhancement.
The patient has abnormal pleomorphic calcifications in the right breast. Stereotactic core biopsy was performed and a representative sample of the calcifications showed DCIS. The remaining calcifications should be assumed to be DCIS as well, even though they do not enhance. Surgical excision is the next best step.
Don't be fooled by the absence of enhancement on CEM!!
DCIS and invasive cancer (although less frequently) can present with suspicious calcifications that do not enhance. Follow-up imaging or return to screening is not appropriate. Breast MRI is not needed. The findings on breast MRI would be similar to those on CEM. Extra points if you saw the HAIR ARTIFACT on the left CC view.
D'Orsi CJ, Sickles EA, Mendelson EB, Morris EA, et al. ACR BI-RADS' Atlas, Breast Imaging Reporting and Data System. Reston, VA, American College of Radiology; 2013
Houben IP, Vanwetswinkel S, Kalia V, et al. Contrast-enhanced spectral mammography in the evaluation of breast suspicious calcifications: diagnostic accuracy and impact on surgical management. Acta Radiol. 2019 Sep;60(9):1110-1117.
Cheung YC, Tsai HP, Lo YF, et al. Clinical utility of dual-energy contrast-enhanced spectral mammography for breast microcalcifications without associated mass: a preliminary analysis. Eur Radiol. 2016 Apr;26(4):1082-9.